title: Clinical navigation for beginners: the clinical utility and safety of the Paramedic Pathfinder.
abstract: BACKGROUND
  English Ambulance Services are faced with annual increases in emergency demand. Addressing the demand for low acuity emergency calls relies upon the ability of ambulance clinicians to accurately identify the most appropriate destination or referral pathway. Given the risk of undertriage, the challenge is to develop processes that can safely determine patient dispositions, thereby increasing the number of patients receiving care closer to home.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the clinical utility and safety of triage support tools (Paramedic Pathfinders).
  
  
  METHODS
  Two triage filters (Pathfinders) were developed (one medical, one trauma). These were applied by ambulance clinicians to 481 patients who had been transported to emergency departments (EDs). Preferred (gold standard) patient dispositions were established by senior medical practitioners using both ambulance and ED clinical records. The clinical utility of ambulance clinicians using Pathfinders was evaluated against this gold standard.
  
  
  RESULTS
  The Medical Pathfinder was applied to 367 patients (76.3%) and the Trauma Pathfinder to 114 (23.7%). Agreement between ambulance clinician and gold standard was achieved in 387 cases (80.5%) giving the tools a combined sensitivity of 94.83% and specificity of 57.9%. 20.9% of medical patients and 30.7% of trauma patients who had been transported to hospital could have been safely cared for elsewhere.
  
  
  CONCLUSIONS
  Ambulance clinicians using Pathfinders have demonstrated acceptable levels of sensitivity in identifying patients who require ED care. The actual impact of the tools in clinical practice will be dependent on the provision of suitable alternatives to ED.
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, Greater Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Newton
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, Greater Manchester, UK.
authors.forename: Eddie
authors.initials: E
authors.lastname: Tunn
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, Greater Manchester, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Moses
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, Greater Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Ratcliffe
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, Greater Manchester, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Mackway-Jones
mesh_terms: D000553:Ambulatory Care; D003153:Community Health Services; D019091:Critical Pathways; D003661:Decision Support Techniques; D003663:Decision Trees; D004636:Emergency Service, Hospital; D006801:Humans; D020380:Needs Assessment; D012648:Self Care; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D006113:United Kingdom
keywords: Clinical Assessment; Guidelines; Paramedics; Triage